Osteoporosis: Making Bones more Porous than Swiss Cheese 1

Osteoporosis: Making Bones more Porous than a Pumice Stone

Bradley D. Blanchet

University of Cincinnati
Osteoporosis: Making Bones more Porous than Swiss Cheese 2

Osteoporosis: Making Bones more Porous than a Pumice Stone

Osteoporosis: The Silent Thief

Osteoporosis has been called the silent thief. This is because most people aren’t aware

that they are losing bone mass over their later lifespan until they fall and/or fracture a bone.

Being aware of how osteoporosis effects the body and causes other underlying medical issues

can lead to better prevention and intervention strategies to keep individuals safe and healthy.

Osteoporosis is the weakening of bones over time due to the loss of bone mass/mineral density.

This causes bones to become more porous and have larger holes in bone than usual. I am

studying osteoporosis because my grandma has been diagnosed with the disease and she always

asks me questions about it and what can she be doing to best combat it. I want to be able to

answer her questions and help her the best that I can with the knowledge I have researched for

this topic. I also know that the incidence of the population is going to increase in the future and

these might be the patients I will see in my future career so having a background in the disease

will better help me understand my patients and allow me to rehabilitate them the best I can.

Etiology and Risk Factors of Osteoporosis1

There are two different types of osteoporosis primary and secondary. Primary

osteoporosis’s origin is unknown but there are various factors that have been connected to it such

as: aging, sedentary lifestyle, poor diet (primarily not getting enough calcium), decrease in both

gonadal and adrenal function. Secondary Osteoporosis is a result of any medication or condition

that prevent or hinder bone mass accumulation or that promotes an increase rate for losing bone

(Goodman et al., 2021 p.1182). When it comes to osteoporosis, there’s a long list of risk factors

associated. The most recognized risk factor is increased age, mostly 50 years and older. This is

because the peak level of bone mass is reached between the ages of 25-35 in most individuals.
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After this range of ages, the body starts to lose bone mass quicker than it can replace it. Some

other risk factors that lead to osteoporosis are: Hormonal status such as being post-menopausal

losing estrogen or men losing testosterone, amenorrhea, genetics (family history of osteoporosis

or fragile bones in general), sedentary lifestyle (physical inactivity), excess tobacco and alcohol

use, medications used for more than 6 months that cause loss of bone mass such as

corticosteroids/steroids in general, anticoagulants, immunosuppressants, laxatives, antacids, etc.

depression, and diet/nutrition (vitamin C and D deficiencies, calcium deficiency, high fat diet,

high sugar, eating disorders, and low body weight/body mass index). Most risk factors can be

prevented, however others like age, hormonal status such as menopause, being immobile, having

depression, and being lactose intolerant are not preventable. The others can be intervened to

prevent osteoporosis such as: quitting tobacco, lessening the intake of alcohol, becoming more

active, eating a better diet, and stopping medications that cause bone loss. Other diseases and

disorders may also cause osteoporosis such as: eating disorders, malabsorption disorders,

endocrine disorders, medication related disorders, sickle cell disease, cancer, metabolic acidosis,

etc. (Goodman et al., 2021 pp.1182-1185).

Incidence and Prevalence of Osteoporosis. Goodman et al. (2021), states that around 43

million individuals in the US “already have low bone mass (osteopenia)” (p.1181). This

increases their risk of getting osteoporosis later on in life due to aging factors. According to the

National Osteoporosis Foundation, the prevalence of osteoporosis in the US is approximately 10

million individuals but is expected to increase due to the number of people at risk already with

osteopenia (Osteoporosis Fun Facts).

Categories and Types of Medications for Osteoporosis. According to Goodwin et al.

(2021) the following pharmacotherapy medications should be used for management of

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osteoporosis: Bisphosphonates, administered orally, intravenously, hormonal therapy for both

men and women, calcitonin, administered nasally or by injection, parathyroid hormone, and

osteoprotegerin (p. 1190). The purpose for all of these classes of medications is to either decrease

the amount of osteoclast activity in the body or to increase osteoblast activity so osteoblasts can

work more effectively and efficiently to build bone up (Osteoporosis Canada 2017). In addition

to medications, diet and nutrition play a huge part in maintaining and preventing additional bone

mass loss. This would include an increase intake of calcium and phosphorus to build bones,

Vitamin D to help regulate the levels of calcium in the body, and increasing protein intake to

promote good bone formation (Goodman et al., 2021 pp.1185).

Physical Therapy Implications of Osteoporosis. The biggest risk and effect of

osteoporosis on the ability to participate is the increased risk of falling and fractures during

interventions. Individuals with osteoporosis may have a fear of falling, a lower independence for

daily activity and quality of movement (may use an assistive device) and may take longer to go

through movement or motions (Goodman et al., 2021 pp.1191-1184). The modification of PT

intervention should shift to risk fall prevention and fracture prevention. This would include

applying a weight bearing exercise training program to increase the stress on bones to encourage

bone remolding and stronger bones (higher bone mass). These exercises could be as simple as

walking, jogging, or running depending on the age and status of the patient. With patients who

have assistive devices or may need them, education and fitting should be accurate to prevent

injury. Balance activities should be implemented to prevent the risk of falling which could lead

to fractures. Flexibility training can be implemented to help with osteoporosis and posture. With

the age of patients at most risk, a fracture would lead to delayed healing and an extended period

of time for recovery (Goodman et al., 2021 pp.1190-1194).

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References

Goodman, C. C., Fuller, K. S., & Goodman, C. C. (2021). Section 3: Pathology of the

Musculoskeletal System, Chapter 24: Metabolic Disorders, Etiologic Factors. In Goodman

and FULLER'S Pathology: Implications for the physical therapist (5th ed., p. 1182-1194).

Elsevier.

National Osteoporosis Foundation. (n.d.). Osteoporosis Fast Facts. www.nof.org.

http://cdn.nof.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf.

Osteoporosis Canada. (2017, November 10). Bisphosphonates: Osteoporosis CANADA.

Osteoporosis. https://osteoporosis.ca/about-the-disease/treatment/bisphosphonates/.